From the *Department of Anesthesiology, Cardiovascular and Thoracic Division, University of Pittsburgh, Pittsburgh, Pennsylvania; †Department of Anesthesiology, Cardiothoracic Division, Duke University, Durham, North Carolina; and ‡Departments of Anesthesiology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.
Anesth Analg. 2014 Apr;118(4):731-43. doi: 10.1213/ANE.0000000000000115.
Extracorporeal membrane oxygenation (ECMO) is a method of life support to maintain cardiopulmonary function. Its use as a medical application has increased since its inception to treat multiple conditions including acute respiratory distress syndrome, myocardial ischemia, cardiomyopathy, and septic shock. While complications including neurological and renal injury occur in patients on ECMO, bleeding and coagulopathy are most common. ECMO is associated with an inflammatory response promoting a hypercoagulable state, requiring anticoagulation to avoid thromboembolism originating in the nonendothelial surfaced circuit. However, excessive anticoagulation may result in bleeding complications including intracerebral hemorrhage. Monitoring anticoagulation for ECMO has its origins in cardiopulmonary bypass for cardiac surgery; however, there is no ideal level of anticoagulation, no standardized method to monitor anticoagulation, nor are all centers standardized on what is used for anticoagulation. Multiple blood products are used in an effort to decrease bleeding in the setting of anticoagulation, often in the setting of recent surgery, and this leads to significant increases in cost for patients on ECMO and transfusion-related complications. In this review article, we discuss the evolution of the various modalities of ECMO, indications, contraindications, and complications. Furthermore, we review the different strategies for anticoagulation and treatment of coagulopathy while on ECMO. Finally, we discuss the cost of ECMO and associated blood product transfusion.
体外膜肺氧合（ECMO）是一种维持心肺功能的生命支持方法。自其诞生以来，它已被用于治疗多种疾病，包括急性呼吸窘迫综合征、心肌缺血、心肌病和感染性休克，其应用不断增加。虽然 ECMO 患者会出现包括神经和肾脏损伤在内的并发症，但出血和凝血障碍最为常见。ECMO 与炎症反应相关，可导致高凝状态，需要抗凝以避免源自非内皮表面电路的血栓栓塞。然而，过度抗凝可能导致出血并发症，包括脑出血。ECMO 的抗凝监测起源于心脏手术中的体外循环；然而，目前没有理想的抗凝水平，也没有标准化的抗凝监测方法，并非所有中心都对用于抗凝的方法进行标准化。为了减少抗凝治疗中的出血，经常在最近手术后使用多种血液制品，这导致 ECMO 患者的成本显著增加，并出现与输血相关的并发症。在这篇综述文章中，我们讨论了 ECMO 的各种模式、适应证、禁忌证和并发症的演变。此外，我们还回顾了 ECMO 期间抗凝和凝血障碍治疗的不同策略。最后，我们讨论了 ECMO 的成本和相关的血液制品输注。
